Slide 1

Fire Chief Harry Beck Mesa Fire and Medical Department Gary Smith, MD Medical Director, Mesa Fire and Medical Department Fire-Based EMS The Next Generation Slide 2 Purpose Describe a model of Fire-Based EMS for proven performance and efficiencies under the Affordable Care Act. Slide 3 City of Mesa, Arizona 137 square miles 440,000 residents (2010) 85,000 winter visitors (2010) 75,000+ > 62 years of age Diverse Population Slide 4 21 ALS Engines 5 ALS Ladders Community Paramedics Private Ambulance Mesa Fire and Medical Department 2 Community Care Units 20 Fire Stations 55,938 Total Calls 80 % Fire Based EMS Slide 5 Mesa Fire and Medical Dispatch Analysis 2013 Mesa 911 Calls55,938 Medical Emergency Calls45,854 Low Acuity Calls10,061 Slide 6 Community Care Initiative Slide 7 Low Emergency Response Model Features Improves Availability for Response to High Emergencies Improves Availability of Ambulances and ERs 911 Based Operated from Fire and Medical Response Model Integrates Partnerships Slide 8 Low Emergency Response Model Features Allows Partner Billing No City Billing at This Time No change in PM Scope of Practice Tiered Triage and Deployment Alternate Destination/Admission Avoidance PCP Referral Slide 9 Captain Paramedic & Firefighter Two Response Units Low Acuity Patients Peak Time Deployment Priority Dispatch Triage Treat and Refer Community Paramedic Unit (TRV) Slide 10 Community Care Nurse Practitioner Unit Captain Paramedic & Nurse Practitioner Nurse Practitioner Provided by Mountain Vista Hospital Treat and Refer to PCP CLIA Waived Laboratory Tests Provide Alternative Destination Patient Follow-up Peak Time Deployment Provide Support to Law Enforcement Slide 11 Community Care Behavioral Health Unit Captain Paramedic and Behavioral Health Specialist Dispatch to Definitive Care in 1-Hour 45-Minutes Alternate Destination Video Slide 12 Proven Model Air Date: January 2013, KSAZ-TV Slide 13 Cost Comparison Emergency Room Costs 2013 Source: Kliff,S. An Average Emergency Department Visit Costs More Than an Average Months Rent. The Washington Post. 2 March 2013 Slide 14 Transport to ER$1,000$0$1,000 Registration$525$0$525 Physician Assessment$325$150$175 Decision Making$950$0$950 MFMD Cost$375$375$0 Emergency Care Charges Low Acuity Medical Patients Past Model New Model $2,650 Total Savings per Patient Savings Slide 15 Emergency Care Charges Behavioral Health Patients Transport to ER$1,000$0$1,000 Initial Evaluation$3,500$150$3,350 3-Day ER Hold$6,000$0$6,000 Inter-Facility Transport$1,000$0$1,000 MFMD Cost$375$375$0 Past Model New Model Savings $11,350 Total Savings per Patient Slide 16 Medicare28%44% Medicaid37%36% Private15%19% None20%1% Community Care Response Behavioral Health Community Care ResponseBehavioral Health Unit Insurance Coverage 2013 Slide 17 Projected Cost vs. Benefit Detail Slide 18 EMS Prevention Model Features Reduces EMS Calls Supported by Call Center RN Tiered Triage Coordinates with Providers Integrates Partnerships Slide 19 Incorporates City Billing Assists with Sustainability Provides Post-Hospital Services Provides GAP Services Reduces Hospital Admissions EMS Prevention Model Features Slide 20 Loyalty Customer Program Proactive Service Reduction of EMS Calls Partnership with ACO Slide 21 Transitional Care Program 72-Hour Post-Discharge Contact Partnership with Physician (PCP/Specialist) Proactive Service Reduces Readmissions Transition to Home Health Sustainable Slide 22 Hospice Comfort Pack Program Coordinated with Hospice Provider Maintains Patient Qualification Improves/Maintains Care Eliminates Transport Sustainable Slide 23 Crisis Prevention Outreach Programs Target Populations Facilitates Access to Appropriate Service Facilitates Intervention Behavioral Health Partnership Slide 24 Community Based EMS Programs Direct Community Involvement Partnership with Good Samaritans Awareness/Education/Training MICR/CPR Training First Aid Training Hospital Partnerships Immunizations School Partnerships Slide 25 What When Where Why Slide 26 The Reason We Are Still Needed Slide 27 and Needed Less Slide 28 The Fire Service is Getting More Expensive Slide 29 Slide 30 Slide 31 Mobile Integrated Healthcare Programs Pilot programs focus on Patient Navigation 9-1-1 Nurse Triage EMS Loyalty Programs Readmission Avoidance Hospice Revocation Avoidance 23-hour Observation Avoidance Require Agility Slide 32 Core Reform Strategies Public Reporting: engaging consumers and other stakeholders Health Information Technology: enabling improvement Value-Based Payment: rewarding achievement Clinically Integrated Delivery Systems: achieving patient centered care Slide 33 A Future System Affordable Accessible to care and to information Seamless and Coordinated High Quality timely, equitable, safe Person and Family-Centered Supportive of Clinicians in serving their patients needs Engaged with the community and fulfilling its populations unique needs Slide 34 Developmental Needs Cost Recovery Shared Savings Pay-For-Performance Capitation ACO Involvement Fire Station Based Clinics 72 hr. Patient Follow-Ups Research Evidenced-Based Quality Assurance Slide 35 To view a copy of this presentation www.mesaaz.gov/fire Find us: mesafiredept East Valley Wellness AZ www.evwellness.com Slide 36 IASIS Healthcare (One of the largest healthcare organizations in the US) 176 Beds 15 Bed Emergency Department 55,000 ED visits a year Level 3 Trauma, Stroke Center, Cardiac Center Mountain Vista Medical Center Public-Private Partnership Slide 37 Mesa Fire and Medical Model National Health Care Major Issue Cost of Health Care - 17.9% GDP Evolving Issues Creation of Accountable Care Organizations CMS Grant Opportunity Impact of Affordable Care Act Resulting Changes to CMS Slide 38 Affordable Care Act Community Care Initiative: Aims and Drivers Slide 39 Behavioral Health Dispatch to Definitive Care in 1 hr 45 min Video Slide 40 Citywide BLS Calls 2013 Slide 41 Behavioral Health/Substance Abuse 2013 Slide 42 Behavioral Health/Suicide Threat 2013 Slide 43 2012/13 Community Care Response Pilot Community Care Response Unit 2012/13 CCR Responses 1,250 Directed to Appropriate Care500 (40%) Medicaid3,723 Medicare2,817 Private1,509 Uninsured2,012 Directed to Appropriate Care (potential)4,024 2012/13 Low Acuity Response Analysis (based on current dispatch protocols) Slide 44 Cost Response Apparatus Community Care Response Unit Average Per Patient Total $375 Human Resource Captain Paramedic and Nurse Practitioner or Behavioral Specialist) Supplies/Equipment $20 $45 $310 Slide 45 Behavioral Health Unit Insurance Coverage Including Patients with no Insurance Information 2013 Medicare18% Medicaid15% Private8% None1% No Information59% Slide 46 Behavioral Health Unit Insurance Coverage 2013 Medicare44% Medicaid36% Private19% None1% Slide 47 Billing Information for Behavioral Health Unit Information Provided by the Mental Health Provider 2013 Private 23% Medicare 3% Uninsured 29% Medicaid/Medicare/Magellan 45% Slide 48 Community Care Response Unit Expansion of the model Public-Private Partnerships Higher Education for Members Enhance public access Fire Station Based Clinics Determine demographics Slide 49 Public School Partnerships Communication Center Centralized Medical Direction On site medical direction Telemedicine Business/Special Events Integrate into health care systems The Next Generation Slide 50 Post Surgical Checks Injury Prevention Community Based EMS Behavioral Health Intervention Sustainability Healthcare Information Exchange Slide 51 Not to replace the Primary Care Physician